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Medical Animations: a Survey and a Research Agenda

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Medical Animations: a Survey and a Research Agenda Eurographics Workshop on Visual Computing for Biology and Medicine (2019) B. Kozlíková, L. Linsen, and P.-P. Vázquez (Editors) Medical Animations: A Survey and a Research Agenda Bernhard Preim 1 and Monique Meuschke1 1University of Magdeburg & Research Campus STIMULATE, Germany Abstract Animation is a potentially powerful instrument to convey complex information with movements, smooth transitions between different states that employ the strong human capabilities to perceive and interpret motion. Animation is a natural choice to display time-dependent data where the dynamic nature of the data is mapped to a kind of video (temporal animation). Clipping planes may be smoothly translated and object transparency adapted to control visibility and further support emphasis of spatial relations, e.g. around a tumor. Animation, however, may also be employed for static data, e.g. to move a camera along a predefined path to convey complex anatomical structures. Virtual endoscopy, where the virtual camera is moved inside an air-filled or fluid-filled structure is a prominent example for these non-temporal animations. Animations, however, are complex visualizations that may depict a larger number of changes in a short period of time. Thus, they need to be assessed in their capability to actually convey information. In this paper, we give a survey of temporal and non-temporal animated visualizations focussed on medical applications and discuss the research potential that arises. To be employed more widely, cognitive limitations, e.g. change blindness, need to be considered. The reduction of complexity in temporal animations is an essential topic to enable the detection and interpretation of changes. Emphasis techniques may guide the user’s attention and improve the perception of essential features. Finally, interaction beyond the typical video recorder functionality is considered. Although our focus is medicine, the discussion of a research agenda is partially based on cartography, where animation is widely used. Categories and Subject Descriptors (according to ACM CCS): Animation 1. Introduction multiple coordinated views for interactive data exploration. Synchro- nized visualizations of internal and external 3D views are typical Computer-generated animations have a long tradition. Powerful for virtual endoscopy [JLS∗97]. animation tools were developed already in the 1980s, primarily motivated by the needs of the film industry. Computer-generated Animations may be used for surgical planning and training animations are created based on metaphors from traditional films, [ÇK00,MBP06], and for anatomy education [HH95,PRS96]. Also like a story board and key frames that are interpolated to achieve the use of animations for patient education [KKSP08,McG10] and smooth transitions. Animation provides enormous flexibility. A vir- forensic use cases [Fis08, VOH17] was extensively studied. While tual camera may be rotated in a fixed distance around a pathology forensic use cases require a high degree of realism (referred to as to assess its morphology (orbiting). The virtual camera may display scientific animations), patient education benefits from plausible, a region around a pathology, zooming in particularly interesting abstracted visualizations where also aesthetic aspects are consid- regions, e.g. to assess an infiltration, or it may zoom out and move to ered. In contrast, animations for medical education are driven more another interesting viewpoint. The camera may also be moved inside by learning-theoretic considerations, e.g. motivational aspects and structures, e.g. in bronchoscopy or colonoscopy [LJK95]. Animated cognitive load theory. displays provide motion parallax, an essential depth cue that sup- ports the interpretation of volume rendered images and maximum Like static medical visualizations may benefit from carefully intensity projections that are otherwise difficult to interpret [SGS95]. chosen default values, the parameters that guide an animation may be re-used in similar cases, e.g. to report cases with a similar pathology Animation may also be used to smoothly change parameters of a in a reproducible manner [IHT∗02, MP10b]. In addition to these transfer function and thus to display or hide structures, to change col- animations, where no dynamic process is visualized, animation is ors or textures for emphasis of focus objects and to adjust clipping a natural choice to display dynamic medical image data, such as planes or more complex resection geometries. Virtually every param- simulated or measured blood flow [dHJEV16], motion of the heart eter of a static display may be smoothly changed to a different state. wall [JAES87] and other functional processes. “Animation let us While most animations are restricted to one viewport, multiple syn- observe how an object changes its shape, size, and position . over chronized animations may provide different perspectives—similar to time” [AWM10]. c 2019 The Author(s) Eurographics Proceedings c 2019 The Eurographics Association. Bernhard Preim & Monique Meuschke / Medical Animations: A Survey and a Research Agenda Animated visualizations may be completely predefined with no or Other areas of visual perception, such as color and contrast per- only basic interaction. At the other end of the spectrum, highly cus- ception, shape and depth perception as well as flow perception are tomized animations may be created on demand where the user has also relevant for animation design. For the sake of brevity, we do full control over all parameters. Thus, the purpose ranges from com- not discuss these other areas. As a starting point for dealing with munication of known facts with predefined, often carefully prepared the role of perception in visualization, we recommend the work of animations to exploratory data analysis [DMKR92]. COLIN WARE [War12]. Since a large number of medical animations has been created with general purpose software instead of dedicated Medical visualization comprises both direct volume rendering systems for medical use, we mention major tools in Sect. 2.3. controlled by a transfer function and (polygonal) surface rendering. These two families of visualization techniques also occur in medical animation. However, surface-based rendering is clearly prevailing. 2.1. Cognitive and Perceptual Basics This is due to the large flexibility to adjust polygonal models, e.g. by smoothing or simplifying them [McG10]. Another argument for The design of animations has to consider a number of aspects re- the use of surface models is that medical animations often contain lated to perception, cognition, motivation and learning theory. The additional elements, such as surgical instruments or crime weapons effectiveness of animations may depend on [RCL09] in forensic animations that are represented as surface model. • the actual content to be displayed, So far, there is no survey article on animation in medicine. Ani- • the specific processes that are shown, mation in other areas, however, was discussed in a number of survey • learner characteristics, such as domain knowledge and spatial articles. The most recent of these articles relate to character ani- abilities as well as mation, in particular to muscle modelling [CRPPD17], hand and • the context in which the display of animations is embedded, e.g. finger modeling [WWS∗15], and more general to physics-based verbal instructions. approaches to character animation [GP12]. There is a slight overlap Research in this area is not comprehensive and in particular medi- to the topics discussed in these articles with respect to biomechanics. cal animations are not investigated well. Thus, our discussion also However, the specific examples of animation using principles from considers non-medical animations. The amount to which experi- biomechanics are different: We consider examples in forensics that ences from other areas, such as cartography and mechanics, can be were not part of previous surveys. Other surveys focussed on the generalized towards medical use cases is currently not clear. application of animation to photorealistically generated images, e.g. ∗ ∗ Wald et al. [WMG 09]. The survey of Kreiser et al. [KMM 18] Motion perception is the rather low-level process of identifying describes projection-based medical visualization techniques. It is and assessing movements. An essential aspect is the ability to detect briefly mentioned, since flattened visualizations may be animated changes at all. In a series of experiments, it was demonstrated that similar to animated maps in cartography. However, Kreiser et al. do users may miss even movements of larger characters known as not discuss any animated technique. change blindness [SL97]. Change blindness has a number of reasons, including saccadic eye movements that occur when a new region Organization. In this paper, we give an overview of animation in an image is fixated. For a period of up to 200 ms, humans are design (Sect.2) and discuss how these methods can be applied blind during these eye movements [Gre15]. Not only that humans to medical visualization. Patient-specific animations are useful for do not reliably detect changes, they are also not aware that they diagnosis and treatment planning. However, the effort to generate have not fully understood a video sequence. Thus, even users who animations must be strongly reduced in clinical medicine. Therefore, miss essential changes report to be certain in their decision—a we discuss strategies to re-use animations in Sect.3. In Section4 we phenomenon called change blindness
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